The paradigm of messaging has not changed since the age of carrier pigeons; namely, a sender constructs a message and tries to find the recipient so as to deliver the message payload. Over centuries the methods of message delivery have improved, but in truth all advances have simply accelerated this exact unilateral messaging model. For example, the horse and carriage message delivery eventually gave way to railways, which in turn gave way to airmail. Eventually, written communication was supplemented by verbal communication with the invention of the telephone, and with the discovery of radio transmitters wired communication became wireless. Still, the fundamental premise that the originator had to find the target remained the same, whether traveling by horse or by radio waves. More recent technological advances such as pagers, cell phones, voice mail, text messaging (SMS), email and instant messaging have pushed the communication latency down to near zero, but still each of these technologies share a common ancestry with the mediaeval horseman: the message sender must have knowledge of where to find the message recipient. Translated into real-life terms, the message originator must have apriori knowledge of the target's “address” [choose: phone number, pager number, SMS number, email address, IM address] or else the sender cannot “deliver” their message to their intended target.
The desire to push message delivery latency towards zero has mandated that potential recipients of messages disclose their addresses, electronic or otherwise, to others. Moreover, by natural extension, the farther and wider individual (electronic) addresses are dispersed, the faster any particular communication payload will reach recipients. When considering the increasing demand for real-time communication in modern society, it would seem conclusive for individuals to distribute their electronic addresses to a global audience to enable rapid, if not instant, real-time communications. Yet, juxtaposed against this desire for real-time communication is the imperative matter of individual privacy. While a wide publication of personal addresses could propel real-time communication and instant message delivery, it would clearly bear a negative impact on personal privacy. Such an action would provide complete strangers indiscriminate, unfettered and immediate access to recipients. Inappropriate individuals and organizations could then flood recipients with irrelevant—if not inappropriate—communications thereby creating an electronic traffic jam in personal communication highways. In simpler terms, the desire for real-time communication quickly leads to a law of diminishing returns whereby the greater the ability for others to reach recipients instantly, the less the recipients' ability to manage and act upon relevant and time sensitive communications.
Attempts to manage these conflicts have been made in our personal (private) lives. Most individuals will err on the side of caution and limit the disclosure of their electronic addresses in favor of privacy. For example, individuals provide their cell phone numbers to selective individuals and avoid unnecessary disclosure of email addresses to avoid spam messages. In their personal lives, individuals are willing to tolerate some delay in communication transactions in favor of privacy. While an “inner circle of friends and family” are empowered with sufficient details for real-time communication, the “rest of the world” finds us at a reduced speed, such as by US postal mail. For example, most individuals would not wish to provide private cell phone numbers to, say grocery store managers, so that they may call them with the latest in-store specials. While the delay in grocery store messaging may “cost” a good bargain, various factors including the desire for privacy naturally deter individuals from revealing methods of real-time messaging to such an organization.
In sum, it may be reasonable to conclude that in their personal lives, individuals can attempt to converge onto a balance between a desire for real-time messaging and a need for privacy. A middle ground may be sought which may be vastly different among individuals.
Achieving this balance is far more elusive in the workplace, especially in industries with a mobile workforce such as healthcare where workflow (aka productivity) is highly dependent upon the arrival of information to the individual. A mobile healthcare workforce has no reliable fixed address such as a desk phone, since they do not remain stationary in any consistent manner. And even at times when healthcare workers are stationary, their “stations” may physically change from one hospital ward to another, or from one patient room to the next. Moreover, while healthcare workers do engage computer terminals, they do so at inconsistent times and for variable durations depending upon the stage of patient care. Hence, healthcare organizations are faced with the following dilemma: a mobile workforce whose productivity—and hence patient care—depends upon information delivery, but whose workers are not consistently and uniformly accessible via any real-time electronic means. To complicate matters further, it is often not practical to permit self-designed strategies for real-time communication at the workplace. Not only would the ensuing confusion be paralyzing, but moreover, some individually designed methods may actually be counter productive leading to a decrease in productivity and raising concerns around patient safety.
The ensuing paradox is that while each employee has a developed set of electronic addresses, which they personally prefer for real-time communication, employers cannot make systematic use of those means. As discussed earlier, personal privacy issues among other factors prevents individuals from voluntarily publishing their personal cell phones addresses simply to enhance workflow productivity. Moreover, disclosing personal electronic addresses for work purposes could also lead to “work spam” wherein messages may come into our personal addresses at inappropriate times while off-work. Worse yet, some of such messages may be of an urgent nature leaving the off-work employee in a troublesome conundrum of how to respond—if at all. There would be little argument from any employee or employer that publishing private worker electronic addresses for workflow optimization would invariably lead to work-life imbalance. For example, asking physicians or nurses to widely publish their personal mobile number in order to improve patient care could lead to a flood of trivial calls, leading to a counter-productive constant interruptions while at work, and a significantly decrease quality of life at home should these numbers reach patients or their families.
In short, it is without question that healthcare organizations have a real and pressing communication dilemma. Their mobile workforce depends on information delivery to remain productive and to deliver quality care, yet real-time communications using an employee's private electronic addresses seems a completely nonviable option. To resolve this conflict, healthcare organizations have resorted to complex and expensive means of enabling communication and collaboration among their employees and partner providers. Sadly, the returns on the investment have been marginal at best.
The most common strategy has been to assign an electronic “work-device” so that during work-hours this electronic address, distinct from private life electronic addresses, can be used for communication and messaging. These work-address initiative have included solutions such as issuing pagers, leveraging expensive nurse triage phone systems, overhead paging of physicians, using answering-service staff, installing back-office phone lines, issuing mobile phones, providing computers on wheels, issuing PDAs, tablets, laptops and so on; the list of endpoint devices and technologies tried by healthcare systems for interpersonal communication is practically endless. Regrettably, none of these technologies have actually been able to deliver on the promise of real-time communication as judged by the ability of a system to enhance productivity through the elimination of wait-states. Even when an endpoint device actually offers the opportunity for a real-time collaboration, such as via a mobile phone or nurse triage phone, the deployment scenarios invariably require the caller to patch through a third party! For example, to reach a nurse on the nurse triage phone systems, one has to first contact the unit clerk who then transfers to the nurse if she is available, or when physicians are issued mobile phones, the caller typically has to request a call back via a pager since the mobile number is still be deemed private despite being employer issued. Overall, the diversity of technologies used has resulted in significant financial strain on organizations already operating at lean margins, while still not delivering on the promise of a real-time enterprise. When considering the capital expense combined with the burden of training, support, maintenance and upgrades, it's simply a marvel that no single solution has emerged to deliver real-time communication for this mobile healthcare workforce—until now.
One problem is that traditional systems operate from the wrong base assumption; one that dates back to the horseback mailman, namely, that it is the duty of the message originator to have apriori knowledge of the target address, or else spend precious time finding the target address in advance of communicating. It is this assumption that has led to the conflict of privacy versus real-time efficiency, and has—almost by accident—caused organizations to adopt futile and expensive technologies to solve the wrong problem. The process of publishing individuals' various electronic addresses not only poses questions surrounding privacy, but also moreover creates a non-scalable situation. In a mobile healthcare workforce, there are innumerable potential addresses for an individual depending on a multitude of workflow factors, most of which is not even known to the message originator. In the absence of this workflow information, the communication originator has little chance of “hitting” the correct target address on first attempt—even if she had all the latest correct addresses (itself a weak assumption at best).
The message originator has to inefficiently iterate though a list of potential addresses (try nursing station, try MD back line, try pager, try cell phone, try overhead paging, etc. . . . ) in the hopes of finding the target. All the meanwhile, work productivity has entered a wait-state, and with it patient care and throughput has been negatively impacted.
Thus, a need exists for improved communication techniques that may meet a need for real-time communications while maintaining privacy. A further need exists for communication facilitation that may assist with enhancing workplace productivity while maintaining work-life balance.